Staying Together

Many years ago, as a new social worker in a large hospital, an elderly couple came in together with two different issues and were admitted to my floor. They had been married well over 60 years and had never spent time apart. The husband had dementia but knew his wife. In the day they found each other but they were in separate rooms and the staff were faced with a problem every night when he would wander the halls and climb into bed with other female patients. We realized that he was looking for his wife at bedtime. I began to advocate to allow them to share a room and was faced with opposition as this was not something the hospital had ever done or entertained. Unfortunately, they each had different medical issues and could not return home.

I was reminded of this story this week when I read of the New Brunswick couple, separated after 69 years of marriage because his dementia had worsened and he was deemed to need a level of care not offered in the home he and his wife lived in. 

My story had a bittersweet ending - after many calls and much advocacy, I found a place that would take our couple on the same day. They would be in different areas of the residence but staff would do their best to bring them together as often as possible so they could visit. Not ideal but at least an understanding that for whatever time they had left, they needed to be together as much as possible. 

For the New Brunswick couple, this understanding was clearly not there. Separated this week, the family resorted to calling the press to share their story. 

I am sad that this many years later, with more couples aging together, we don't have a proper mechanism in place to ensure that at this last stage of their lives, they remain under the same roof regardless of differing care needs. As our health care system continues to evolve, this is definitely something that should be added to the list of 'must haves'. We need to find ways to allow couples at different levels of care to stay together and live out the remainder of their days in each other's company. 

Hiring Help

For most people 'there is no place like home' and so, for many who have difficulty managing at home, prior to considering relocation, they consider/investigate hiring extra help in the home. For some, adequate help can be found through their local LHIN where costs are covered by OHIP. For others, if funds permit and the care available through the LHIN is not enough for them to feel safe, they investigate hiring through a private agency. As with any private care service for a vulnerable population, one is wise to do their homework prior to hiring anyone. Senior care is the new up and coming field with many new companies who may or may not have adequate training and experience. One needs to ensure that whomever they hire is reliable, trustworthy and able to provide exactly what they promise. As with any private service it is always best to contact more than one company and interview both the agency and the care providers before they begin working for you. It would be best if you have a written list of questions to ask each company/provider prior to speaking with them. As well, ask to see a copy of the client contract in advance and ask if they can provide references.
Some suggested questions to consider when interviewing an agency to purchase services from include:

• How long have they been in business?

• What sort of memberships/licenses/accreditation do they have?

• What qualifications do employees have?

• Do they do background/criminal checks and reference checks for all new staff?

• Are staff trained to manage cognitive impairment, behavioral issues, vision issues and hearing issues?

• How do they monitor their staff & track hours?

• Are there surprise visits by a supervisor?

• Are staff licensed, insured and bonded?

• Will the same staff person visit your loved one every time or will there be different people providing service?

• What is the cost of services required?

• Is there a minimum number of hours required for a client to commit to?

• How often do they increase fees & how much notice do they give you before an increase?

• Are staff protected by the Workplace Safety and Insurance Board (WSIB)?

• What is the procedure if a caregiver is sick?

If there are specific needs your loved one has, do include that in your list of questions as well as anything else you think is important to know when you hire someone to provide care. 

Aging with Confidence: Ontario's Action Plan for Seniors

A couple of weeks ago the Ontario government announced a new document and with it, their commitment, to helping seniors age well. Entitled Aging with Confidence: Ontario's Action Plan for Seniors the document outlines "Ontario's vision [to] help seniors remain independent, healthy and active, safe and socially connected." Using different sources of a data as well as a survey of seniors, the government has created a plan aimed at encompassing the changing needs of seniors as the population become more diverse and lives longer. There are several "guiding principles" at the report's core - Inclusion, Diversity, Choice and Self-Determination & Safety and Security.
With this goal, the province hopes to support seniors regardless of their age or stage, health or income, and physical needs.

An all-encompassing website for seniors has been created at Ontario.ca/AgingWell. It has information on health, transportation, housing, activities and financial assistance. While many of the initiatives are encouraging to consider (education, consumer protection, helping with technology, etc.) what is most interesting from my perspective, given the issues I hear about most, are those related to housing.... I do want to see more age-friendly communities, I do want to know that seniors will get more home support to live independently in their own homes for as long as possible, I want to read about more naturally occurring communities where there are many seniors and supports are sufficient, I want to know that there is more supportive housing for those on limited incomes, and I want to know about better long-term care - less wait times, more support, more staff, more innovation, more protections, more homes for those with cultural needs and more modern homes. Ultimately, I want to see the end to the big black hole in senior care - I want to be able to help people like the man who called me today who is on a limited income but needs a retirement home. I want to be able to tell him that our government has a solution for his situation.

The vision is a good one. The initiatives are encouraging. I hope getting to the reality is not too many years in the making. 

For more information on the Aging With Confidence document visit: https://www.ontario.ca/page/aging-confidence-ontario-action-plan-seniors

GUEST POST - The Importance of Staying Active in Your Golden Years

So you haven’t exactly found hitting the big 6-0 to be motivation for improved fitness. The good news is, there’s still time. If you haven’t been practicing healthy eating and living a healthy active lifestyle, you can still improve your health by starting now.

The science of aging works a bit against us in our golden years. As we age the correlation between our body fat and our lean body mass changes, and it isn’t for the better. So, instead of muscle working to raise our metabolism and burn fat, there’s far less muscle to do the job. This means as we age we must work hard to follow a low calorie diet, and harder at following an exercise plan to go with it.

According to the American Journal of Clinical Nutrition, several population studies among the older generation (65+) found that following a healthy nutrition plan, along with a healthy lifestyle plan: 1) reduces the risk of cancer by one third, and 2) decreases the risk of cardiac events by as much as 45%.

In addition to decreasing physical health, the older population also faces significant mental health issues. The World Health Organization reports that 20% of world’s elderly population, 60 and over, suffers from a mental or neurological disorder. They further recommend “optimizing physical health” as one of the most important components of intervention.

It’s time to get motivated with these easy tip.

Strength Training. To build more muscle mass as you age, start with strength training. Stronger muscles make day-to-day activities much easier. A study by The US National Library of Medicine National Institutes found that, “muscle mass can be increased through training at an intensity corresponding to 60% to 85% of the individual maximum voluntary strength.”

If the idea of strength training at a gym is intimidating, consider creating your own home gym with a few select pieces of equipment. Read about proper form to avoid injury and find a free online weight training program that’s best for you and that can be done from the comfort of your own home. Remember: doing something is better than nothing, so allow yourself to ease into it and work your way up when you’re ready.

Get Moving. Like strength training, a good walk can increase muscle mass, but walking also has so many other benefits:

·        Weight control

·        Improve balance and coordination

·        Keeping joints flexible

·        Lowers your risk for heart disease

·        Improves your energy

·        Decreases depression and anxiety

Consider purchasing a Fitbit. The Fitbit, worn around your wrist most commonly, tracks your daily steps via a pedometer. Keeping yourself accountable for moving so much each day, and increasing your efforts, will motivate you to move more. Consider competing with a friend for most steps in a day. The American Heart Association recommends 10,000 steps a day as a goal for improving health and lowering your chances of heart disease. As always, start with a small goal and work your way up.

Try Yoga. Numerous studies have shown that yoga has many health benefits, particularly in the 50-plus age group. Here’s a few of them:

·        AARP published a study suggesting that the slow, controlled breathing required for yoga leads to a decrease in hypertension and stress, and may lead to a decrease in medication use.

·        The American Osteopathic Association reports that yoga “creates mental clarity and calmness; increases body awareness; relieves chronic stress patterns; relaxes the mind; centers attention; and sharpens concentration.”

Head to your local retailer, and purchase a yoga mat for as little as $15. These mats can be used for yoga, as well as for your home strength training.

Easy home exercises. Start working on easy home exercises that will help you build your strength and coordination.

·        Free Exercise for Seniors and the Elderly

·        6 Easy Everyday Routines for Strength and Balance

Remember, a sedentary lifestyle can lead to numerous diseases of the mind and the body. Find fun ways to incorporate daily exercise into your life, and sooner than you know it, the ole 5-0 will feel more like the younger 3-0. 

Post Submitted by: Marie Villeza, Elderimpact.org

Marie Villeza is passionate about connecting seniors with the resources they need to live happy, healthy lives. So she developed ElderImpact to provide seniors and their caregivers with resources and advice.

Who decides when you can’t?

Personal Choice. Self-determination.  Your right to decide about your own care; where you want to live; what you want to eat; who you want to look after you; where to spend your money – these choices and our ability to make them for ourselves, allow us to feel in control of our own life. They are the things most people take for granted; the things we think we will always be able to do for ourselves. But, what if one day you can’t? What if either because of an illness that gradually robs you of the ability to do these things or, an injury that does so suddenly, this is taken away from you? Who will make these decisions for you? While this is not something anyone likes to talk about, the reality is, it is a very important thing to raise and discuss this with people you care about, regardless of age or situation because none of us knows what tomorrow will bring. Planning for what you would like to happen, in the event that you need someone else to make decisions for you in the future is called “Advance Care Planning” and the legal documents that support this in Ontario are a Power of Attorney for Personal Care and a Continuing Power of Attorney for Property. Every person over 18 should have both.

A Power of Attorney for Personal Care is a legal document that appoints one or more people the right to make decisions on your behalf that specifically relate to your care or treatment if you are deemed incapable of making those decisions for yourself. Your “attorney” should be the person or persons you trust and they are your “substitute decision maker(s)”. They should be someone who knows you and what you would want in most situations.  While they may not share your values and beliefs, they should understand them and be willing and able to uphold them, in the event that they are asked to make a decision on your behalf. It would be best if you had conversations with that person (or persons) about your wishes in the event that you require care/medical intervention in the future.

A Continuing Power of Attorney for Property is a legal document that allows at least one person to act on your behalf if you become incapable of managing your financial affairs. This person can be but does not have to be, the same person as your substitute decision maker. You should trust that the person (or persons) can properly manage your financial affairs as they will have full authority to manage your money and property.

You do not need a lawyer to draft your Powers of Attorney though, it would be wise to consult one and have him/her prepare the necessary documents. There are some basic components all Powers of Attorney need to have in order to be valid, so if you choose not to have a lawyer create one for you, you may download a basic form from the Office of the Public Guardian and Trustee at www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poa.pdf  that can be completed on your own.

Once you have completed your Powers of Attorney, keep the originals in a safe place and make sure that you have at least one copy that is easily accessible. Ensure those you have asked to be your attorney(s) are aware of their potential responsibilities and tell them of the whereabouts of the original documents.

Thoughts on Downsizing

Downsizing. Whether it's when the kids leave home, when we need to relocate because of health issues or any time in between, just about everyone at some point or another in their lives will have to consider how best to decrease their possessions. The task can be daunting, especially for those who have lived in the same house for a lifetime. So what is the best way to dispose of things you no longer, need, want or have space for? It would be ideal if one starts cleaning out rooms, drawers and closets over time rather than waiting until just before you must move. It's easier to gradually pare down what you own when you are not rushed or under pressure.

If  have seniors in your life that you suspect will need to downsize soon, it makes sense to help them identify what they need, what the want, and what they would like to give away. Encourage them to give their valuable, special or memorable items to family members and perhaps even let them choose what they would like. Gifting special items to loved ones provides an ideal opportunity to reminisce and share stories about the past which in turn preserves the family history. Keep in mind though that not everyone may want items that you consider special and conversely, there may be things that are not overly meaningful to you but hold special memories for a younger loved one.

If there are things that no one wants but you believe to be valuable, have them appraised so you can determine if you are best off selling them or giving them away. Consider donating items that are not valuable but still useful. So organizations may be willing to provide a tax receipt for donations which may be more beneficial than the money you can make from selling them. Many things that you think are valuable may not be and may not be worth the effort to try to sell. For large items or a large volume of items that you want to throw out, you may want to contact a junk removal company to dispose of them.  Ensure that you check all drawers in furniture and pockets in clothing that you are getting rid of to ensure you haven't put something in a 'safe' place and simply forgotten about it.

If there are family photos and mementos, entrust someone in the family to be the 'keeper of the memories'. Consider making a digital album that can be shared by everyone and perhaps even incorporate stories about the content that your elder loved ones have shared.

As difficult as downsizing can be, taking it slowly, involving your loved ones in decision making and respecting their wishes can make the task easier and far less stressful.

HomeSharing

Always looking for innovative senior housing options, I came across something interesting recently. A couple of areas are testing out HomeSharing projects. With this model, younger seniors in need of accommodation are being matched with older seniors living alone who need basic assistance or simply companionship. The younger senior helps out in exchange for reduced rent, and the older senior shares their home and has a someone to keep them company and help out around the house. As long as the two are matched well and get along, this concept seems like a wonderful idea with many benefits for all involved. 

This project,  in its infancy in both Northumberland County and the Halton Region would be worth following to see how successful it is and if it is adopted by other regions. A bit like the co-housing model but on a smaller scale, this does have potential as something communities can build on and eventually create groupings (of HomeSharing units where there are many seniors) that can also share care and assistance among them. It can be a good solution for well seniors who need a bit of assistance to remain independent but don't want to move into a retirement home setting or for those who live in smaller communities where there are not available retirement living options. 

As our senior population grows, we will be forced to look at more and more innovative ways to house them  in settings that allow for independence while providing them with a bit of assistance. This is one example of how we can do this and I look forward to following its progress.